Abstract
PURPOSE: Current guidelines classify PH due to lung disease and/or hypoxia (group 3) as pre-capillary PH (mean pulmonary artery pressure (mPAP) ≥25mmHg and mean pulmonary capillary wedge pressure (mPCWP) ≤15mmHg). In the setting of lung disease, multiple mechanisms of disease play a role apart from classical pulmonary arteriopathy, hypoxia, hypercapnia, mechanical stress of hyperinflated lungs, emphysematous and fibrotic changes, inflammation and toxic effects of cigarette smoke. We hypothesized that a significant proportion of patients with PH due to lung diseases carries a post-capillary component.
METHODS: A large database (n=3107) of right and left heart catheterizations was interrogated.
RESULTS: Of 291 patients with PH due to lung disease, 96 patients had normal hemodynamics (“Non-PH” mPAP<25mmHg). Of the remaining 195 patients with PH, 53 were classified as pre-capillary PH (mPCWP ≤15mmHg), and 142 had elevated left ventricular filling pressures (mPCWP >15mmHg). Multivariate analysis identified stable ischemic heart disease as an independent predictor of survival (p=0.014).
Table 1. Age and hemodynamic characteristics of patients with pulmonary hypertension due to lung disease and/or hypoxia
CONCLUSION: The data demonstrate that a significant proportion of patients with PH due to lung disease suffers from post-capillary pulmonary hypertension.
- © 2013 ERS
